Outcomes of Kyphoplasty Versus Pedicle Screw Fixation for Osteoporotic Vertebral Compression Fractures: A Comparative Analysis.

Abstract

The incidence of osteoporotic vertebral compression fractures (OVCFs) has steadily risen in recent years due to an aging general population. Symptomatic OVCFs can be treated via different methods, including kyphoplasty (KP) and pedicle screw fixation (PSF). Few studies have compared short- and long-term outcomes in patients undergoing either KP or PSF. A systematic search of PubMed, SCOPUS, and Cochrane was conducted to identify meta-analyses, randomized controlled trials, observational studies, and cohort studies comparing KP and PSF for the management of OVCFs according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles referencing vertebral compression fractures secondary to metastasis or myeloma were excluded. Separate meta-analyses were performed to summarize proportions for extracted study outcomes. Patient-reported outcomes included significant pain relief and return-to-function at short-term and final follow-up. Objective outcome measures included radiographic evidence of vertebral height restoration, occurrence of adjacent-level disease, medical and surgical complications, and reoperation rates. In total, 48 articles were included (16 PSF, 33 KP, with 1 study reporting both), comprising 3643 patients. Overall, 98% of patients reported pain relief in the immediate postoperative window, which decreased to 97% for KP at an average follow-up of 18.7 (±9.2) months and 92% for PSF at 37.2 (±23.7) months. Both KP and PSF are safe and comparable surgical options for patients presenting with OVCFs, with sustained pain relief and improvements to functional status at long-term follow-up. Prospective, randomized trials are warranted to further elucidate any significant discrepancy in patient outcomes.